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A ringing sound in the ear is a common symptom of tinnitusQ: I have a constant ringing sound in my right ear, which can be annoying, especially when I am in a very quiet room. Our cochlear hair cells emit sounds which can be recorded by advanced hearing test equipment. It can also be related to inner ear disorders resulting from infection, trauma, loud noise exposure, medications and tumours in the pathway of the auditory nervous system. More commonly, acute tinnitus is associated with sudden hearing loss that develops over 72 hours.
Others will experience distress, inability to rest, frustration, problems with concentration, fears, worries and even headaches.
About 75 per cent of patients who have acute tinnitus get better with time because of brain plasticity and adaptation. For the majority of these patients with pulsatile tinnitus, the physicians are not able to hear the sound through auscultation of the head and neck with the stethoscope and generally, no cause is found on X-ray imaging. Another group of patients with audible pulsatile tinnitus (sounds which the physician can hear following auscultation) would require radiographic imaging to exclude small dural arterio-venous fistulas (abnormal connection or passageway between two vessels that normally do not connect) or vascular brain tumours. For many others for whom the cause of the tinnitus is not found on physical examination and even after various investigations, such as magnetic resonance imaging scans to exclude important treatable inner ear conditions, basic counselling, tips on how to avoid silence and the use of enriched environmental sounds can help.
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It can result from hearing loss due to impacted ear wax in the ear canal, a perforated ear membrane, middle ear effusion (build-up of fluid) due to nose cancer or infection, middle ear bone scarring due to infection or another condition called otosclerosis (an abnormal bone growth in the middle ear) from a childhood measles infection. Some patients can be affected to the point of developing sleep disturbances coupled with anxiety and depression. The remainder of patients will still hear the noise but they get used to this, while a minority (5 per cent) will need medical help to cope. The patient with audible pulsatile tinnitus needs early management and treatment before further complications set in. Removing the ear wax will help those who have tinnitus arising from blocked external ear canals.
It is a directed counselling therapy and utilises enriched environmental sounds or noise generators to train the brain to adapt to the tinnitus. I am a 60-year-old man and I use a hearing aid in my right ear when I conduct training sessions. This has been reported to be present in 17 per cent of the general population and increases to 30 per cent in those more than 65 years old. We generally do not hear these sound energies as our external sound environment will invariably mask them. Most patients in the acute stage of tinnitus will complain of annoyance, impact on their lifestyle and difficulty coping in quiet environments, especially at night, when the tinnitus sound is magnified due to the absence of ambient noise.

In this group of patients, they hear simple, pure tone sounds such as buzzing, cricket noises or high-pitched sounds or a combination of these. One patient described hearing Singapore’s national anthem Majulah Singapura, while another described hearing cries of “hallelujah”. When this is due to sudden hearing loss with no known cause, a trial of steroids, antiviral medications or antioxidant treatments has been reported to improve the hearing and, subsequently, the tinnitus. These patients have to be distinguished from a more common group of patients who suffer from schizophrenia.
Another group of patients hear repeated tapping noises because of middle ear myoclonus, a condition that results from twitching of the middle ear muscles. I have checked with a doctor and he has found nothing wrong with the ear, but has suggested that I see a specialist.
To quote Professor Pawel Jastreboff, the founder of Tinnitus Retraining Therapy: it results from the brain over-compensating for the presence of a small irregularity in the functioning of the cochlea or auditory nerve.
Yet others will hear a rhythmic sound, in time with their heartbeat, defined as pulsatile tinnitus.